Abstract Details

Title Droxidopa and Midodrine Treatment Persistence in Patients With Orthostatic Hypotension

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-047

Objective To determine the treatment persistence of droxidopa and midodrine in patients with orthostatic hypotension (OH) or neurogenic OH (nOH) when medication cost was not a factor

Background OH is a sustained drop in blood pressure upon standing that can lead to falls, impaired function, and poor quality of life; nOH is OH with a neurogenic etiology. Droxidopa and midodrine are approved in the United States to treat symptomatic nOH and symptomatic OH, respectively.

Design/Methods Retrospective analyses of patients prescribed either droxidopa or midodrine were performed using the Symphony Health Solutions Database (Symphony Health; Conshohocken, PA, USA). Inclusion criteria were continuous healthcare coverage from 9/2014 to 6/2017, an active prescription for droxidopa or midodrine of ≥30 days’ duration during that period, and no copay ($0.00) for the prescribed drug. Persistence was capped at 365 days. Statistical difference between estimated survival curves for droxidopa and midodrine was calculated using a log-rank test and a multivariable Cox regression analysis.

Results Data from 688 patients on droxidopa (mean age, 63.8 years; 48% women) and 1888 patients on midodrine (mean age, 55.2 years; 62% women) were included. Patient diagnoses in the droxidopa and midodrine groups were Parkinson disease (12% and 1%), cardiovascular disease (34% and 70%), both Parkinson disease and cardiovascular disease (18% and 3%), and unknown (36% and 26%). Median (95% CI) persistence was significantly longer for droxidopa vs midodrine (240 [210–299] vs 180 [160–183] days; P<0.0001). Patients on midodrine were 27.4% more likely to become non-persistent than those on droxidopa when adjusted for demographic and clinical factors (P=0.002).

Conclusions When medication cost is not an influencing factor, patients using droxidopa were more likely to remain on treatment than patients on midodrine. The reason for this is unknown, but could be due to enhanced efficacy or fewer side effects.

Authors/Disclosures
Lawrence Hewitt (Lundbeck) PRESENTER	Lawrence Hewitt has received personal compensation for serving as an employee of Lundbeck.
Steven Kymes	Steven Kymes has received personal compensation for serving as an employee of Lundbeck. Steven Kymes has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Journal of Ophthalmology. Steven Kymes has received research support from Emmes Corporation.
Kenneth Jackson, PharmD (Lundbeck)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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